Wound care and ostomy questions blend assessment, safety, and teaching. Work through these 10 practice questions on the phases of healing, tissue types, modern dressing selection, drains, and stoma assessment, including the dusky stoma that signals an emergency, each with a full rationale.
Wound Care & Ostomy: Healing, Dressings, Drains & Stomas
Wound care and ostomy content shows up constantly on the NCLEX because it blends assessment, safety, and client teaching. Anchor yourself in the four phases of healing: hemostasis (clot forms), inflammatory (redness, warmth, and edema in days 1-4), proliferative (beefy-red granulation tissue and new capillaries, roughly days 5-21), and maturation/remodeling (the scar strengthens for up to a year). Know the three closure types too: primary intention (clean, surgically approximated edges), secondary intention (an open wound that granulates from the base up), and tertiary/delayed primary intention. When you assess a wound, describe size and depth, the tissue in the bed (granulation = healthy beefy-red; slough = yellow/tan stringy; eschar = black/brown necrotic), drainage (serous = clear, sanguineous = bloody, serosanguineous = pink, purulent = thick/colored = infection), tunneling/undermining, and periwound skin. Infection clues are increasing pain, spreading redness/warmth, purulent or foul drainage, and fever.
Modern dressing selection follows one rule: keep the wound bed moist and the periwound skin dry to speed epithelialization. Match the dressing to the exudate: transparent film (minimal drainage/protection), hydrocolloid (light-to-moderate drainage, occlusive, supports autolytic debridement), foam (moderate-heavy), alginate (heavy exudate; seaweed-derived), and hydrogel (adds moisture to a dry wound). Wet-to-dry gauze is an outdated, nonselective mechanical debridement method that also strips healthy tissue and hurts, so it is not preferred for clean granulating wounds. Debridement types are autolytic, enzymatic, mechanical, and sharp/surgical. Closed-suction drains (Jackson-Pratt, Hemovac) are emptied and then recompressed to restore gentle suction; a Penrose is an open drain.
For ostomies, output reflects anatomy: an ascending colostomy drains liquid stool, a transverse colostomy mushy/semi-formed stool, and descending/sigmoid colostomies more formed stool, and an ileostomy puts out constant liquid effluent rich in fluid, electrolytes, and skin-damaging enzymes, so dehydration and peristomal breakdown are top risks. A healthy stoma is beefy-red/pink and moist, and slight bleeding with cleaning is normal, but a dusky, purple, or black stoma signals ischemia and is an emergency to report. Fit the skin barrier snugly, empty the pouch at about one-third full, and teach clients to chew well, add foods gradually, and (with an ileostomy) avoid high-fiber foods that can cause blockage.
Before you start, review the NPIAP definitions for every stage, including unstageable and deep tissue injuries, in our pressure injury staging guide.
Wound Care & Ostomy NCLEX Practice Questions
Question 1 · Wound Healing Phases
A nurse is teaching a nursing student about the phases of wound healing. During which phase does beefy-red granulation tissue form as new capillaries develop, typically between days 5 and 21?
- A Hemostasis phase
- B Inflammatory phase
- C Proliferative phase
- D Maturation (remodeling) phase
Show answer & rationale
Correct answer: C
The proliferative phase (roughly days 5-21) is when fibroblasts lay down collagen, new capillaries form (angiogenesis), and beefy-red granulation tissue fills the wound bed, followed by epithelialization across the surface. This is the correct answer because granulation is the hallmark of proliferation. Hemostasis is wrong because it is the immediate first response: platelets aggregate and a fibrin clot forms to stop bleeding, occurring in minutes to hours, with no granulation tissue. The inflammatory phase (days 1-4) is wrong because it is characterized by vasodilation, redness, warmth, and edema as neutrophils and macrophages clear debris and bacteria; it prepares the wound but does not yet build granulation tissue. The maturation/remodeling phase is wrong because it occurs after the wound has closed, up to a year later, as collagen reorganizes and the scar gains tensile strength (still only about 70-80 percent of original skin strength). Clinical pearl: remember the order with 'Healing Is Progressively Mending' — Hemostasis, Inflammatory, Proliferative, Maturation. If you see healthy beefy-red tissue building up from the base, the wound is proliferating and healing well; protect it and keep the bed moist. Recognizing normal granulation also prevents the error of debriding healthy tissue, which is why nonselective wet-to-dry gauze is discouraged on clean granulating wounds under current standards.
Question 2 · Wound Assessment / Tissue Type
A nurse assesses a sacral pressure injury and notes the wound bed is covered with dry, black-brown, leathery tissue. How should the nurse most accurately document this finding?
- A Granulation tissue
- B Slough
- C Serous exudate
- D Eschar
Show answer & rationale
Correct answer: D
Eschar is dry, thick, leathery, black or brown necrotic (dead) tissue and is the correct term for what is described. Eschar often must be assessed carefully because a wound covered in stable eschar cannot be accurately staged, and unstable or infected eschar may require debridement. Granulation tissue is wrong because it is healthy, beefy-red, moist, bumpy tissue that signals healing, not necrosis. Slough is wrong because slough is yellow, tan, gray, or green soft, stringy, moist nonviable tissue; while it is also nonviable, its color and consistency differ from black leathery eschar. Serous exudate is wrong because that term describes drainage, not tissue in the bed; serous drainage is thin and clear, seen in normally healing wounds. Clinical pearl: color-code the wound bed — Red is ready (granulation, protect and keep moist), Yellow is yucky (slough, may need debridement), and Black is bad (eschar, necrotic). Per current pressure-injury guidelines, a wound that is fully obscured by slough or eschar is 'unstageable' until the necrotic tissue is removed enough to visualize the base. Accurate documentation of tissue type drives the treatment plan, including whether autolytic, enzymatic, mechanical, or sharp/surgical debridement is indicated.
Question 3 · Dressing Selection
A nurse is selecting a dressing for a wound with heavy exudate. Which seaweed-derived dressing is designed to absorb heavy drainage while maintaining a moist wound environment?
- A Alginate dressing
- B Transparent film dressing
- C Hydrogel dressing
- D Hydrocolloid dressing
Show answer & rationale
Correct answer: A
Alginate dressings are derived from seaweed (brown algae) and are highly absorbent, making them the correct choice for wounds with heavy exudate; they form a gel on contact with drainage and help maintain a moist bed while wicking excess fluid away. A transparent film dressing is wrong because it is nonabsorbent and semi-occlusive, best for wounds with minimal or no drainage, for protecting intact or superficial areas, or as a secondary dressing; on a heavily draining wound it would trap fluid and macerate the periwound skin. A hydrogel dressing is wrong because its purpose is to ADD moisture to a dry wound bed (for example, a wound with eschar or minimal exudate); using it on a heavily exudating wound would worsen maceration. A hydrocolloid dressing is wrong because it is intended for light drainage and provides an occlusive, insulating environment that supports autolytic debridement; it lacks the absorptive capacity for heavy exudate. Clinical pearl: match absorption to exudate — think 'Alginate = A lot' of drainage, foam for moderate-to-heavy, hydrocolloid for light, film for minimal, and hydrogel to hydrate a dry wound. The overarching principle is keep the wound bed moist and the periwound skin dry; choosing an under-absorptive dressing on a wet wound violates that rule and delays epithelialization.
Question 4 · Wound Infection
A nurse is assessing a surgical wound during a dressing change. Which findings should the nurse recognize as signs of a wound infection? Select all that apply.
- A Pain at the site that decreases each day
- B Spreading redness and warmth around the wound
- C Thin, clear serous drainage
- D Purulent, foul-smelling drainage
- E Temperature of 101.5 F (38.6 C)
- F Increasing pain and tenderness at the wound
Show answer & rationale
Correct answer: B, D, E, F
Signs of wound infection include spreading redness and warmth, purulent/foul drainage, fever, and increasing pain, so those four findings are correct. Spreading erythema and warmth reflect an escalating inflammatory and infectious process extending into surrounding tissue. Purulent, foul-smelling drainage (thick, colored — yellow, green, or brown) indicates bacterial infection and is distinctly abnormal. A temperature of 101.5 F is a systemic sign that the infection may be affecting the whole body. Increasing pain and tenderness, rather than the expected gradual improvement, is an early and reliable infection clue. Pain that decreases each day is wrong because improving pain is the normal, expected trajectory of a healing wound, not a sign of infection. Thin, clear serous drainage is wrong because serous exudate is normal in a healing wound; infection is signaled by purulent drainage, not clear fluid. Clinical pearl: use the classic infection cues — increasing pain, spreading redness/warmth, purulent or foul drainage, and fever — and remember that a healing wound should hurt LESS over time, not more. On the NCLEX, a wound that is getting more painful, redder, warmer, or draining pus after the first few days should trigger notification of the provider and consideration of a wound culture per current infection-control standards.
Question 5 · Drains
A nurse empties 40 mL of serosanguineous fluid from a client's Jackson-Pratt (JP) drain. To re-establish suction, what should the nurse do next?
- A Leave the reservoir bulb open to air
- B Fully compress the bulb and replace the plug
- C Irrigate the drain tubing with sterile saline
- D Clamp the drainage tubing for one hour
Show answer & rationale
Correct answer: B
A Jackson-Pratt is a closed-suction drain that works by negative pressure. After emptying and measuring the output, the nurse fully compresses (squeezes flat) the reservoir bulb and then replaces the plug while it is compressed; as the bulb tries to re-expand it creates gentle suction that pulls fluid from the wound. This is why compressing the bulb and replacing the plug is correct. Leaving the reservoir open to air is wrong because an open, expanded bulb generates no suction, so drainage would pool at the site and increase infection and hematoma risk. Irrigating the drain tubing with saline is wrong because a JP is a closed system that is not routinely irrigated; introducing fluid risks contamination and is not standard practice without a specific order. Clamping the tubing for an hour is wrong because it would obstruct outflow, cause fluid to back up, and defeat the purpose of the drain. Clinical pearl: for closed-suction drains (JP and Hemovac), the memory aid is 'empty, measure, compress, cap' — you must recompress to recreate suction. Always record the amount, color, and characteristics of the output, assess the insertion site for signs of infection, and verify the tubing is patent and secured. A Penrose, by contrast, is an open drain that relies on gravity and is not compressed.
Question 6 · Ileostomy
A nurse is caring for a client with a newly created ileostomy. Which characteristic of the stoma output should the nurse anticipate?
- A Formed, solid stool once or twice daily
- B Firm, dry stool passed infrequently
- C No output at all for the first week
- D Constant liquid, enzyme-rich output
Show answer & rationale
Correct answer: D
An ileostomy diverts stool from the ileum, before the large intestine has reabsorbed water, so the output is constant, liquid, and rich in fluid, electrolytes, and digestive enzymes — making that the correct expectation. Because water is not reabsorbed, dehydration and electrolyte imbalance are major risks, and the enzyme-laden effluent is highly damaging to peristomal skin, so a snug skin barrier is essential. Formed, solid stool once or twice daily is wrong because formed stool comes from the distal colon; you would expect it with a descending or sigmoid colostomy, not an ileostomy. Firm, dry stool passed infrequently is wrong for the same reason — the ileum does not produce firm stool, and ileostomy output is nearly continuous rather than infrequent. No output at all for the first week is wrong because, while there may be a brief postoperative period before function returns, a functioning ileostomy produces near-constant liquid drainage, not a week of nothing. Clinical pearl: 'ileostomy = irritating liquid.' Teach the client to watch for high-output dehydration (increase fluids and electrolytes), protect the skin meticulously, empty the pouch when about one-third full, and avoid high-fiber foods that can cause a food blockage. This contrasts with a colostomy, where output becomes progressively more formed the more distal the stoma.
Question 7 · Stoma Assessment
A nurse is assessing several clients' stomas. Which findings require the nurse to notify the provider immediately? Select all that apply.
- A A stoma that is beefy-red and moist
- B A dusky, purple-colored stoma
- C A small amount of bleeding when the stoma is cleaned
- D Black-brown discoloration of the stoma
- E A pale, dusky stoma several hours after surgery
- F A pink stoma that protrudes slightly with minimal edema
Show answer & rationale
Correct answer: B, D, E
A healthy stoma is beefy-red or pink and moist, so color changes toward dusky, purple, or black are the emergencies here. A dusky, purple stoma signals impaired perfusion (ischemia) and must be reported immediately. Black-brown discoloration indicates necrosis (tissue death) and is a surgical emergency. A pale, dusky stoma several hours postoperatively likewise reflects compromised blood flow and must be reported before the tissue becomes frankly necrotic — early recognition can save the stoma. The beefy-red, moist stoma is wrong as an answer because that is the expected, healthy finding requiring no intervention. A small amount of bleeding when cleaning is wrong because the stoma is highly vascular mucosa, and slight oozing with gentle cleaning is normal, not an emergency. A pink stoma that protrudes slightly with minimal mild edema is wrong because mild edema and slight protrusion are normal early postoperative findings; the stoma should stay pink/red and moist. Clinical pearl: 'red or pink is fine; dusky, purple, or black is a page.' Assess stoma color, moisture, and protrusion every shift early on, and remember that perfusion is the priority — any color signaling ischemia (dark, dusky, purple, black) is reported STAT because delayed intervention risks losing the stoma.
Question 8 · Moist Wound Healing
A nurse is reviewing the principle of moist wound healing with a new graduate. Which statement best reflects current wound-care standards?
- A Keep both the wound bed and the periwound skin dry to prevent infection
- B Keep the wound bed moist and the periwound skin dry to speed healing
- C Keep the wound bed dry so a scab can form and protect the wound
- D Keep the periwound skin moist to soften the tissue around the wound
Show answer & rationale
Correct answer: B
Current wound-care standards support moist wound healing: keeping the wound bed moist and the periwound skin dry, which is the correct statement. A moist bed allows epithelial cells to migrate across the surface more easily, speeding epithelialization, reducing pain, and supporting autolytic debridement, while keeping the surrounding intact skin dry prevents maceration and breakdown. Keeping both the wound bed and periwound dry is wrong because a dry wound bed slows cell migration and can cause a hard scab that impedes epithelial resurfacing. Keeping the wound bed dry so a scab forms is wrong for the same reason — the old 'let it dry out and scab' belief has been replaced by moist wound healing, which produces faster closure and less scarring. Keeping the periwound skin moist is wrong because chronic moisture on intact surrounding skin causes maceration (white, soggy, fragile skin) and enlarges the wound. Clinical pearl: the mantra is 'moist center, dry edges.' Dressing selection serves this goal — hydrogel adds moisture to a dry bed, alginate and foam absorb excess exudate to protect the periwound, and barrier products shield surrounding skin. This principle also explains why wet-to-dry gauze is discouraged on clean granulating wounds: as it dries it desiccates and tears away healthy new tissue, working against moist healing.
Question 9 · Dressing Selection
A nurse is matching dressings to wound characteristics. Which pairings are appropriate according to current wound-care principles? Select all that apply.
- A Hydrocolloid dressing to support autolytic debridement
- B Transparent film dressing for a wound with copious drainage
- C Alginate dressing for a wound with heavy exudate
- D Foam dressing for a wound with moderate-to-heavy drainage
- E Wet-to-dry gauze for a clean, granulating wound
- F Hydrogel dressing for a dry wound bed
Show answer & rationale
Correct answer: A, C, D, F
Four pairings are correct. Alginate for heavy exudate is appropriate because these seaweed-derived dressings are highly absorbent. Hydrogel for a dry wound bed is appropriate because hydrogel donates moisture to rehydrate dry tissue and support the moist-healing principle. Foam for moderate-to-heavy drainage is appropriate because foam absorbs larger volumes while cushioning the wound. Hydrocolloid to support autolytic debridement is appropriate because its occlusive, insulating environment traps moisture and lets the body's own enzymes self-digest slough/eschar. The wet-to-dry gauze pairing is wrong because on a clean, granulating wound it performs nonselective mechanical debridement, tearing away healthy new granulation tissue and causing pain; it is an outdated method not preferred for clean granulating wounds. The transparent film for copious drainage pairing is wrong because film dressings are nonabsorbent and semi-occlusive, suited to minimal-drainage wounds, protection, or as a secondary cover; on a heavily draining wound they trap fluid and macerate skin. Clinical pearl: think of a 'moisture ladder' — hydrogel adds moisture, film handles minimal drainage and hydrocolloid light-to-moderate drainage, foam handles moderate-heavy, and alginate handles heavy. Always match absorptive capacity to exudate so the bed stays moist and the periwound stays dry, and reserve mechanical wet-to-dry debridement for situations where nonselective debridement is truly intended, not for healthy granulating tissue.
Question 10 · Colostomy Output
A nurse is teaching a client who has a new sigmoid colostomy about expected stool characteristics. Which description should the nurse include?
- A Continuous liquid output rich in enzymes
- B Loose, semi-liquid stool throughout the day
- C Formed stool like a normal bowel movement
- D Ribbon-like stool with no consistency
Show answer & rationale
Correct answer: C
Colostomy output becomes more formed the more distal (farther along the colon) the stoma is placed. A sigmoid or descending colostomy sits near the end of the colon, where most water has already been reabsorbed, so the client should expect formed stool similar to a normal bowel movement — the correct teaching. Continuous liquid output rich in enzymes is wrong because that describes an ileostomy, where effluent bypasses the colon entirely; a sigmoid colostomy does not produce enzyme-rich liquid. Loose, semi-liquid stool throughout the day is wrong because that pattern is expected with a more proximal ascending or transverse colostomy, where less water has been reabsorbed. Ribbon-like stool with no consistency is wrong because that is not a normal colostomy finding and, in an intact bowel, thin ribbon-like stool can suggest obstruction; it does not describe expected sigmoid colostomy output. Clinical pearl: picture the colon left to right — the farther the stoma is downstream (descending/sigmoid), the more time the colon has had to reabsorb water, so the stool is more solid; the more upstream (ascending/transverse), the looser and more liquid the output. Because a sigmoid colostomy produces relatively formed stool, some clients may be candidates for routine colostomy irrigation to regulate output, and skin protection needs are typically less intense than with an ileostomy.
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Wound Care & Ostomy FAQ
What are the four phases of wound healing in order?
The phases are hemostasis (a clot forms to stop bleeding), inflammatory (redness, warmth, and edema in days 1-4 as debris is cleared), proliferative (beefy-red granulation tissue and new capillaries build the bed, roughly days 5-21), and maturation/remodeling (the scar reorganizes and strengthens for up to a year). A memory aid is 'Healing Is Progressively Mending.' On the NCLEX, recognizing granulation tissue as a sign of the proliferative phase tells you the wound is healing normally.
How do I know which wound dressing to choose?
Match the dressing to the amount of drainage while keeping the wound bed moist and the periwound skin dry. Use transparent film for minimal drainage or protection, hydrocolloid for light-to-moderate drainage and autolytic debridement, foam for moderate-to-heavy drainage, and alginate (seaweed-derived) for heavy exudate. Use hydrogel to ADD moisture to a dry wound. Wet-to-dry gauze is an outdated, nonselective mechanical debridement method that also strips healthy tissue, so it is not preferred for clean granulating wounds.
What does a healthy stoma look like, and when is it an emergency?
A healthy stoma is beefy-red or pink and moist, and a small amount of bleeding when you clean it is normal because the stoma is vascular mucosa. Mild edema and slight protrusion early after surgery are also expected. A dusky, purple, dark, or black stoma signals impaired blood flow (ischemia or necrosis) and is an emergency to report immediately. The memory aid: red or pink is fine; dusky, purple, or black is a page.
How is an ileostomy different from a colostomy?
An ileostomy drains constant liquid effluent that is high in fluid, electrolytes, and skin-damaging digestive enzymes, so dehydration and peristomal skin breakdown are major risks and skin barrier protection is critical. Colostomy output depends on location: an ascending colostomy drains liquid stool, a transverse colostomy mushy/semi-formed stool, and descending/sigmoid colostomies more formed stool. Ileostomy clients should chew well, avoid high-fiber foods that can cause blockage, stay well hydrated, and empty the pouch when it is about one-third full.